Provider Demographics
NPI:1912940123
Name:SHAHAB, SYED MASOOD (M D)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:MASOOD
Last Name:SHAHAB
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 S LATSON RD
Mailing Address - Street 2:STE 200
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-7660
Mailing Address - Country:US
Mailing Address - Phone:810-494-6800
Mailing Address - Fax:810-229-4990
Practice Address - Street 1:1225 S LATSON RD
Practice Address - Street 2:STE 200
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-7660
Practice Address - Country:US
Practice Address - Phone:810-494-6898
Practice Address - Fax:810-338-2417
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI057162207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4661704Medicaid
MI4661704Medicaid
MION96790Medicare ID - Type UnspecifiedMEDICARE NUMBER
MIN96790002Medicare PIN